Publicación a texto completo no autorizada por el autor / Muestra los resultados y complicaciones en el manejo del hallux valgus, operados con las técnicas más utilizadas en el Centro Médico Naval, lo cual permitirá al personal de salud perfeccionar el conocimiento y práctica sobre el tema, así también conocer mejor las indicaciones para determinada técnica quirúrgica con el fin de disminuir sus complicaciones. Se evaluaron 70 casos operados desde enero 2004 hasta agosto 2013, teniendo en cuenta la edad, el sexo, el pie afectado, patologías agregadas, la presencia de artrosis, inestabilidad, técnica quirúrgica utilizada, los ángulos IMTT, HV, PASA, DASA pre y post quirúrgicos y las complicaciones postquirúrgicas con un seguimiento mínimo de 6 meses. La edad promedio fue 43.56±19.04 años, predominio sexo femenino y pie izquierdo, las osteotomías distales (Chevron y Bosch modificado) corrigieron adecuadamente los HV leves y moderados, mas no el severo y en el caso del Bosch modificado en su mayoría produjo limitación para la extensión del hallux; la técnica de Lelievre y la artrodesis corrigieron parcialmente el ángulo IMTT en su mayoría, pero calmaron el dolor del hallux, aunque algunos quedaron con metatarsalgia residual, la osteotomía basal corrigió adecuadamente el hallux severo, pero tuvo recidiva en 3 casos ya que no se corrigieron las deformidades asociadas y/o presencia de inestabilidad, en la mayoría de pacientes en los que persistió el dolor fue por la mala elección de la técnica. El cirujano deberá escoger la técnica apropiada para la corrección del HV, teniendo cuidado en el manejo de las partes blandas, hacer un buen planeamiento preoperatorio, tomando en cuenta los ángulos referidos, evaluando la artrosis como también la inestabilidad de la articulación cuneometatarsiana y las deformidades adicionales que pudieran causar también el hallux valgus; se deberá también hacer un control postoperatorio adecuado teniendo en cuenta el vendaje adecuado, para así evitar las correcciones insuficientes, recidivas u otras complicaciones. / Trabajo de investigación

Title: Evaluation plantogram and range of motion of the joints of the lower extremity with hallux valgus deformity. Objectives: The aim of my thesis, "Evaluation plantogram and range of motion of the joints of the lower extremity with hallux valgus deformity" is a statistical comparison of the aspects of the lower limbs in healthy subjects and people affected by hallux valgus deformity. It will be a comparison of the measured values, such as the degree of hallux valgus angle, range of motion of the hip joint to spin, Q - angle of the lower limb, position of hocks and strained soles. Methods: Plantographic evaluation of the strain on the soles on Podoscope, goniometry, photography, plantographic diagnostic method - Chippaux - a Šmírák and Sztriter - Godunov. Results: During this research, I observed twenty seven individuals. Five individuals had hallux valgus deformity, fourteen individuals had valgus position of the thumb and seven individuals had no deformity. In the course of evaluating plantogram and range of motion of the joints of the lower limb with hallux valgus deformity I observed degree of flat. This statement was confirmed at a significant level of p = 0.01 for both legs. Unfortunately in case of individuals with mild hallux valgus deformity, the proximo-distal, or disto-proximal...

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 5 uppsatser.

Både biomekaniska och neuromuskulära faktorer hos kvinnliga fotbollsspelare har visat sig påverka risken att drabbas av främre korsbandsskador. Obalanserad muskelaktivering kring knäleden har visat sig påverka ledstabiliteten. Syftet med studien var därför att undersöka sambandet mellan muskelaktiveringen i vastus medialis och vastus lateralis i relation till valgusvinkel hos fotbollsspelande kvinnor vid ett drop-landingtest. Studien gjordes i samarbete med det finska företaget Fibrux OY, som har utvecklat en bärbar sEMG-apparatur. I studien deltog 15 kvinnliga fotbollsspelare som under en drop-landing bar sEMG-elektroder på vastus medialis och vastus lateralis samtidigt som rörelsen filmades framifrån för att möjliggöra 2D analys av valgusvinkel. Resultaten visar en tendens till samband mellan muskelaktiveringsgrad och valgusvinkel (r=0,51) (p>0,05) samt ett svagt samband mellan muskelaktiveringsordning och valgusvinkel (r=0,32) (p>0,05). Det svaga sambandet gör att det inte går att utesluta att det är andra muskler kring knäleden som har större inverkan på ledstabiliteten. Framtida forskning bör utföras på en större population och rikta sig på prospektiv epidemiologisk forskning eftersom det är den enda studiedesignen som avslöjar vilka variabler som kan associeras med risken att drabbas av en knäskada. / Both biomechanical and neuromuscular factors affect the risk of suffering an ACL rupture among female soccer players. Unbalanced muscle activation around the knee has been found to affect the joint stability. The aim of this study was therefor to investigate the muscle activation in vastus medialis and vastus lateralis in relation to dynamic valgus among female soccer players. The study was conducted in cooperation with the Finnish company Fibrux OY, who has developed a portable sEMG testing equipment. The participants consisted of 15 female soccer players who were tested with sEMG electrodes on vastus medialis and vastus lateralis during a drop-landingtest that was filmed to enable 2D analysis of valgus angle. The results show a tendency to correlation between the activation ratio and valgus(r=0,51) (p>0,05), and between activation delay in vastus medialis and valgus (r=0,32) (p>0,05). But both correlations lack significance. The results could be explained by that there might be other muscles around the knee at that affects the joint stability even more than vastus lateralis and medialis do. Future studies should be conducted with larger sample size and focus on prospective epidemiological research because that is the only study design that reveals what variables can be associated with the risk of suffering a knee injury.

Hallux valgus and hallux limitus are two common foot pathologies that may require surgical intervention. While the modified Austin bunionectomy and the Youngswick osteotomy/cheilectomy respectively, are often used to correct these conditions, insufficient research has been published regarding the effects of these procedures on plantar pressure distribution of the foot. This thesis involves a series of six studies investigating topics relating to radiographic measurements and plantar pressure distribution over a two-year period, in normal feet and in hallux valgus and hallux limitus feet before and after corrective surgery.A review of the literature is presented relating to the development of plantar pressure measurement technology, the aetiology and surgical management of hallux valgus and hallux limitus, the reliability of the EMED system used in the studies, and the related clinical uses of plantar pressure measurement.An initial study was designed to investigate the reliability measurements using a simplified two-step method of data collection as compared to the traditional mid-gait technique of ten normal asymptomatic subjects. Intra-class correlation coefficients were calculated and compared for the pressure variables of contact area, contact time, maximum force and peak pressure of ten regions of the foot.A study to determine normal reference range values for the EMED-SF system was then conducted using thirty healthy subjects and the two-step method of data collection. Descriptive statistical reporting of peak pressure, mean pressure and pressure-time- integrals were presented for ten regions of the foot.Three related studies on radiographic and plantar pressure measurement differences, and their relationships were made using thirty normal, hallux valgus and hallux limitus feet. Various angular and linear radiographic measurements were tested for intra-rater ++ / reliability of measurement and pressure variables of peak pressure, mean pressure and pressure-time-integral of 10 regions of the foot were recorded and one way analysis of variance employed to assess any significant differences.Finally, two independent two-year prospective studies were designed to investigate the effects of the modified Austin bunionectomy for hallux valgus and the Youngswick osteotomy/cheilectomy for hallux limitus on plantar pressure distribution of the forefoot. In addition, fundamental radiographic measurement changes of the forefoot of hallux valgus subjects and range of motion changes of the first metatarsophalangeal joint of hallux limitus subjects were conducted. Thirty-six healthy volunteers acted as control subjects, 31 subjects (44 feet) with hallux valgus and 17 subjects (23 feet) with hallux limitus were included in the study. Using an EMED-SF system, plantar pressure variables of peak pressure, pressure-time-integral, contact time, maximum force and force-time-integral were recorded at six regions of the forefoot, pre-operation and repeated at three, six, 12, 18 and 24-months post-operation for surgical subjects. Control subjects were tested at zero and 24-months. Descriptive statistics, multivariate and univariate analysis of variance with contrasts, t-tests of significance and correlations between certain measurement parameters were used in the analysis of the results.The findings of these studies suggest that the two-step method of data collection of plantar pressure measurements is more reliable that the traditional mid-gait technique for most pressure variables. Consequently, the two-step method was employed as the preferred method of data collection in this series of studies.With respect to radiographic differences between normal, hallux valgus and hallux limitus, it appears that hallux valgus feet have significant increases in ++ / metatarsus primus varus and first metatarsal protrusion distance, while hallux limitus feet have increased hallux abductus interphalangeal angles. Comparison of pressure variables between each group demonstrate hallux valgus feet have a medial localisation of peak pressure beneath the first, second and third metatarsal heads, suggesting that hyperpronation of the foot is associated with the development of hallux valgus. Hallux limitus feet on the other hand, show increased pressure beneath the hallux, third and fourth metatarsals and lesser toes, indicating a more lateral locus of pressure loading, suggestive -of the foot functioning in a more supinated position. No significant relationship was found between any radiographic parameter and pressure variable tested in either group of subjects.Plantar pressure measurement changes show the greatest variation during the initial three to six months following surgical treatment of hallux valgus and hallux limitus. The Youngswick osteotomy/cheilectomy for the treatment of hallux limitus produces near-normal range of motion of the first metatarsophalangeal joint. Pressures of the first metatarsal head remain relatively constant over the period of measurement, while a significant reduction of the hallux and lateral metatarsals were noted, related to increased dorsiflexion of the hallux. Pressures of the second metatarsal head remained significantly above pre-operation levels. The modified Austin bunionectomy for the treatment of hallux valgus produced 24-month radiographic changes consistent with accepted values. Pressure variables of the hallux reduced to normal values, with the first metatarsal head demonstrating an initial significant decrease and subsequent increase by twelve months post-operation to remain with the second metatarsal head at relatively similar values to pre-operation measurements.The research demonstrates ++ / the two-step method of data collection is a viable means of obtaining reliable plantar pressure measurement data in the clinical situation. The investigations into radiographic and plantar pressure distribution indicate that structural radiographic and functional differences exist between normal, hallux valgus and hallux limitus feet. However, no relationship could be found between any of the radiographic parameters and pressure variables tested.The modified Austin bunionectomy for hallux valgus significantly reduced fundamental radiographic measurements to accepted post-operative values, while the Youngswick procedure for hallux limitus significantly increased the amount of post-operative dorsiflexion of the hallux to normal values. The research demonstrates that immediate and longer-term functional changes to the forefoot occur following the surgical treatment of hallux valgus and hallux limitus, however plantar pressure measurements do not return to normal values. No correlation was found between plantar pressure measurements and post- operative radiographic measurements in the hallux valgus group. However, the increased amount of dorsiflexion of the hallux post-operatively in the hallux limitus group was correlated with reduced lateral loading of the forefoot. Post-operation changes of plantar pressure distribution indicate that the rehabilitative period required to achieve stable foot function is between twelve to eighteen months. Furthermore, plantar pressure measurement technology offers the clinician a useful tool to monitor foot function prior to and following therapeutic intervention.

Made available in DSpace on 2014-06-11T19:24:47Z (GMT). No. of bitstreams: 0 Previous issue date: 2006-01Bitstream added on 2014-06-13T19:11:30Z : No. of bitstreams: 1 teodoro_ecm_me_guara.pdf: 1297352 bytes, checksum: c9d0432c22eb7bba690b0845f261eb9c (MD5) / A proposta do presente estudo foi construir um sistema constituído por duas plataformas de força que fossem eficientes, porém com custo reduzido, de fácil operação e utilizá-las para analisar as forças plantares de sujeitos portadores de hálux valgo (joanete), na tentativa de estabelecer uma possível correlação com o pé tipo plano. Foi selecionado um total de vinte sujeitos, com idade entre 21 e 65 anos (idade média 42 anos), com presença ou não de hálux valgo, por meio de uma avaliação clínica subjetiva. Os sujeitos selecionados foram divididos em dois grupos, sendo um grupo constituído por dez indivíduos portadores de hálux valgo e outro grupo com dez indivíduos com ausência da deformidade. A classificação do arco plantar foi determinada pela impressão plantar e o ângulo do valgismo do hálux foi medido através de radiografias. Cada sujeito pisou num total de 24 vezes sobre as plataformas de força e a atividade baropodométrica foi registrada com os mesmos nas posições, ereta e estática. Através da análise das forças plantares, não foi observada uma correlação entre a presença de hálux valgo e pés planos. / The purpose of the present study was to construct an efficient system constituted of two force plates, however with reduced cost and of easy operation. The force plates aim to analyse the plantar forces of subjects with hallux valgus, in attempt of establishing a possible correlation with the pes planus. It was selected a total of twenty subjects, with ages between 21 and 65 years (mean age 42 years), with presence or not of hallux valgus (bunion), through a subjective clinic avaliation. The subjects selected were subdivided into two groups; one group constituted of ten subjects with hallux valgus and the other group with ten subjects with absence of the deformity. The plantar arc's classification was determined through the footprint and the angle of the hallux's valgism was measured through radiographs. Each subject stepped in a total of 24 times upon the force plates and the baropedometric activity was recorded with the subjects in the static and erect positions. Through analysis of the plantar forces, it wasn't observed a correlation between the presence of hallux valgus and pes planus.

Abstract Hallux valgus is a very common foot deformation and it is also very common reason for orthopaedic surgery in Western industrialised countries, including Finland. In Finland, about 90% of the patients are women. Several early studies support the opinion that distal chevron osteotomy is a predictably successful treatment for mild-to-moderate hallux valgus deformities. Nevertheless, the necessity of chevron osteotomy fixation is controversial and only limited evidence supports the effectiveness of postoperative regimens. In this prospective randomised study, we compared the long-term results of 2 operative techniques (osteotomy fixation versus no fixation) and 2 postoperative regimens (a soft cast versus an elastic bandage) in 100 patients who underwent surgery for hallux valgus. Clinical evaluations based on the American Orthopedic Foot and Ankle Society (AOFAS) scale scoring were performed at baseline and again at 6 weeks, 6 months, 1 year, and a mean of 7.9 years postoperatively. Radiographic measurements were also made of the hallux valgus angle (HVA), first intermetatarsal angle (I/II IMA), distal metatarsal articular angle (DMAA), sesamoid position (LaPorta), congruence of the first metatarsophalangeal joint and the shift of the metatarsal head. Intraobserver repeatability and inter-observer reliability of radiographic measurements were evaluated by an experienced orthopaedic surgeon and an experienced radiologist. The mean AOFAS function scores were better in the group treated without osteotomy fixation and with an elastic bandage at 6 weeks postoperatively, but the difference disappeared at later dates. AOFAS scores were significantly worse when the preoperative hallux valgus angle exceeded 30 degrees. The AOFAS scores did not differ statistically among the groups in our population. Radiological recurrence of hallux valgus deformity of 15 degrees or more was very common at long-term follow-up after distal chevron osteotomy. Preoperative congruence, DMAA, sesamoid positon (LaPorta), HVA and I/II IMA affected recurrence. All recurrences were painless; thus, no revision surgery was required. A statistically higher metatarsal head shift was observed in the fixation group, but the clinical significance of 0.8 mm was very small. The experienced orthopaedic surgeon and experienced radiologist each exhibited good repeatability and reliability. Based on this study, the fixation of the distal chevron osteotomy is not necessary, nor is a rigid soft cast bandage required. The risk of recurrence of hallux valgus is higher when the preoperative HVA is 30 degrees or over. / Tiivistelmä Vaivaisenluu on hyvin yleinen jalan epämuotoisuus ja se on myös hyvin yleinen syy jalkakirurgiaan läntisissä teollistuneissa maissa ja myös Suomessa. Noin 90 % suomalaisista potilaista on naisia. Useat aiemmat tutkimukset tukevat mielipidettä, jonka mukaan ensimmäisen jalkapöydänluun alaosan V-muotoinen luunkorjausleikkaus näyttäisi olevan suositeltava hoito lievän ja kohtalaisen vaivaisenluun hoidossa. Luunkorjauksen kiinnityksen tarpeellisuus on kiistanalainen ja todisteet leikkauksen jälkeisen hoidon tehosta ovat rajalliset. Tässä eteenpäin suuntautuvassa, satunnaistetussa tutkimuksessa vertasimme kahden leikkaustekniikan (luunkorjauksen kiinnitys/ei kiinnitystä) ja kahden leikkauksen jälkeisen hoidon (kevyt kipsisidos/elastinen tukisidos) pitkäaikaistuloksia 100 potilaalla, jotka hoidettiin vaivaisenluun vuoksi. Kliininen arviointi suoritettiin Amerikan ortopedisen jalka- ja nilkkayhdistyksen pisteytyksen mukaan (AOFAS) ennen leikkausta ja 6 viikkoa, 6 kuukautta, 1 vuosi sekä keskimäärin 7.9 vuotta leikkauksen jälkeen. Samoin röntgenkuvista mitattiin vaivaisenluukulma (HVA), ensimmäisen ja toisen jalkapöydänluun välinen kulma (I/II IMA), ensimmäisen jalkapöydänluun alapään nivelpinnan kulma (DMAA), jänneluun asema (LaPorta), ensimmäisen jalkapöydänluun ja varpaan välisen nivelen asento sekä leikkauksessa tapahtunut jalkapöydänluun pään siirto. Röntgenkuvista tehtyjen mittausten toistettavuus ja luotettavuus arvioitiin kokeneen ortopedin ja kokeneen röntgenlääkärin välillä. Keskimääräiset AOFAS toimintapisteet olivat parempia siinä leikkausryhmässä, jossa luunkorjausta ei kiinnitetty ja leikkauksen jälkeen käytettiin joustavaa tukisidosta 6 viikon kontrollissa, mutta seurannassa ero hävisi. AOFAS-pisteet olivat merkittävästi huonommat, jos vaivaisenluukulma oli ennen leikkausta yli 30 astetta. Aineistossamme AOFAS-pisteet eivät eronneet tilastollisesti merkittävästi eri ryhmien välillä. Röntgenkuvissa vaivaisenluukulman uusiutuminen 15 asteeseen tai sen yli oli hyvin tavallinen jalkapöydänluun alaosan chevron osteotomian jälkeisessä pitkäaikaisseurannassa. Ennen leikkausta arvioidut nivelen asema, DMAA, LaPorta, HVA ja I/II IMA vaikuttivat uusiutumiseen. Kaikki uusiutumiset olivat kivuttomia ja uusintaleikkauksia ei tarvittu. Ryhmässä, jossa luunkorjaus kiinnitettiin, jalkapöydänluun pään siirto pysyi tilastollisesti paremmin, mutta 0.8 mm:n eron kliininen merkitys on olematon. Röntgenkuvista tehtyjen mittausten toistettavuus ja luotettavuus olivat hyviä sekä ortopedilla että röntgenlääkärillä. Tämän tutkimuksen perusteella ensimmäisen jalkapöydänluun alaosan luunkorjauksen kiinnittäminen ei ole tarpeellista eikä myöskään ole tarpeen käyttää kipsisidosta. Vaivaisenluun uusiutumisen riski on suurempi, jos vaivaisenluukulma on ennen leikkausta 30 astetta tai enemmän.

Antecedentes: El hallux valgus (HV) es la patología del antepié más frecuente en adultos. Una de las técnicas quirúrgicas más ampliamente aceptada para su corrección es la osteotomía en chevron, cuyo objetivo es la realineación del primer metatarsiano mediante el desplazamiento lateral de su cabeza. Actualmente, no se ha determinado qué magnitud constituye un desplazamiento adecuado y satisfactorio para el paciente. Objetivos: El objetivo principal era analizar la influencia de la magnitud del desplazamiento lateral de la cabeza metatarsiana tras la osteotomía distal en chevron del primer metatarsiano sobre los resultados reportados por el paciente. Los objetivos secundarios fueron: (1) Identificar el desplazamiento mínimo de la cabeza metatarsiana necesario para obtener un resultado satisfactorio; (2) Evaluar si la posición sesamoidea cambiaba con el tiempo e influía en el resultado reportado por el paciente. Material y Métodos: Estudio de cohortes, prospectivo y comparativo de una muestra de 97 pacientes. El resultado clínico se evaluó mediante el cuestionario de calidad de vida Self-reported foot and ankle score (SEFAS), escala funcional de la Sociedad Americana del Pie y Tobillo (AOFAS), escala analógica visual del dolor (EVA) y satisfacción final del paciente con una escala Likert. Radiológicamente, el desplazamiento lateral de la cabeza metatarsiana fue cuantificado mediante: a) ángulo intermetatarsiano (AIM); y b) desplazamiento lineal lateral. Los pacientes se distribuyeron en dos grupos según presentaran un incremento postoperatorio mayor o igual o menor de la diferencia mínima clínicamente importante (DMCI) de 9 puntos en la escala SEFAS. Para el objetivo secundario (1) se realizó un análisis ROC, y para el (2) los pacientes se agruparon respecto a la posición sesamoidea obtenida con la cirugía. Resultados: No se encontró asociación significativa entre la magnitud del desplazamiento lateral de la cabeza metatarsiana medido mediante el AIM y la escala SEFAS al final del seguimiento. Aplicando una curva ROC, no se obtuvo un punto de corte significativo en el AIM para discriminar a los pacientes con un incremento igual o mayor a la DMCI en el resultado SEFAS final (área bajo la curva, AUC= 0,46; p= 0,611). Igualmente, no hubo un punto de corte significativo para el desplazamiento lineal lateral (AUC 0,47; p= 0,730). En el análisis multivariante realizado para identificar factores predictores de SEFAS satisfactorio, fueron significativos las variables finales de EVA-dolor y posición correcta de los sesamoideos. Los 66 pacientes con posición sesamoidea normal obtenida en la cirugía no tuvieron cambios en dicha posición al final del seguimiento. Por el contrario, 8 pacientes (25,8%) de los 31 en que la posición no fue correcta tuvieron un empeoramiento de la posición sesamoidea al final del seguimiento, y peor resultado final en SEFAS (p= 0,003), EVA-dolor (p= 0,026) y satisfacción (p= 0,011). Conclusión: La magnitud del desplazamiento de la cabeza metatarsiana no influye en el resultado funcional reportado por el paciente medido con la escala SEFAS, pero tiene influencia en la satisfacción del paciente con la cirugía. Una incorrecta posición sesamoidea obtenida en la cirugía puede conducir a un empeoramiento de dicha posición con el tiempo y peor resultado funcional. El principal factor de resultado favorable no es tanto la magnitud del desplazamiento lateral de la cabeza metatarsiana como la obtención en la cirugía de una correcta cobertura de los sesamoideos.

Bakgrund: Hallux valgus (HV) är den vanligaste felställningen i foten hos vuxna. HV behandlas främst med operativa behandlingsmetoder men innan operation övervägs ska patienten behandlas med icke-kirurgiska behandlingsmetoder. Det saknas idag riktlinjer kring icke-kirurgiska behandlingsmetoder, vilka de är och vilken effekt de har. Syfte: Syftet med studien var att sammanställa vetenskaplig litteratur som beskriver icke-kirurgiska behandlingsmetoder för hallux valgus. Metod: Studiedesign var narrativ litteraturstudie med systematisk litteratursökning. Sökningar genomfördes i PubMed, CINAHL, MEDLINE och 12 artiklar inkluderades i resultatet. Resultat: De icke-kirurgiska behandlingsmetoder som nämns i litteraturen var rådgivning, ortoser, olika typer av skenor, träning, manuell terapi, tåseparerare, tejpning, elstimulering, kylbehandling och töjning av muskler. Konklusion: Flertalet icke-kirurgiska behandlingsmetoder finns i syfte att behandla HV. Det ligger stor vikt i att tidigt upptäcka HV då metoderna är effektiva vid lindrig till måttlig lateral felställning. Det är troligtvis en kombination av de icke-kirurgiska behandlingsmetoderna som är mest effektiv i syfte att minska komplikationer och minska risk för operativa åtgärder av HV.

No description available.